Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Common symptoms of bronchiectasis include recurrent cough and sputum production. Usually the
mucus is clear, but it may be bloody due to bronchial wall injury or green or
yellow if infection is present. Shortness of breath and fatigue develop as lung
function decreases. Wheezing may or may not be present.
Bronchiectasis may occur due to another underlying disease. Symptoms of that
primary disease may also be present. For example, a patient with tuberculosis
may have bloody sputum, fever,
chills, and night sweats. A
person with
Crohn's disease may have abdominal pain and diarrhea.
Congenital bronchiectasis often becomes apparent because of recurrent
pneumonia.
What is bronchiectasis?
Bronchiectasis is a term that describes damage to the walls of the large
airways, or bronchial tubes, of the lung. Inflammation due to infection or other
causes destroys the smooth muscles that allow the bronchial tubes to be elastic
and prevents secretions that are normally made by lung tissue to be cleared.
Normal branching of the airways of the lung demonstrates a gentle taper that
occurs at each branch point, like the branches of a tree. This tapering results
in decreased resistance in the larger branches, enabling mucus or other objects
to be funneled to the larger airways and eventually, with a cough, ejected out
through the mouth. Loss of this normal anatomic tapering of the airways by
damage due to inflammation causes the walls of the airways to be irregularly
shaped. Secretions tend to pool in the distorted airways rather than be
expelled, and these stagnant secretions are a breeding ground for bacterial
growth. These bacteria, in turn, cause further irritation and inflammation,
airway damage, and hence more secretions, initiating a "vicious cycle" of
damage. This increases the risk of infections to spread directly into the
airspaces of the lungs resulting in pneumonia.
Bronchiectasis is a form of chronic
obstructive pulmonary disease (COPD)
which also includes emphysema and chronic bronchitis. Bronchiectasis can be
present alone, but usually more than one of the aforementioned components of
COPD coexist in the same person.
Congenital bronchiectasis may occur due to a genetic defect such as occurs in
cystic fibrosis. Usually, the disease Alpha-1 antiprotease (alpha 1-
antitrypsin) deficiency results in emphysema, but bronchiectasis can occur as
well in this condition. An embryologic defect in the airway cilia, so-called
immotile cilia syndrome, is another cause of bronchiectasis and is often
associated with situs inversus, in which the major organs are in a reversed
position (for example, the heart is on the right).
Pediatric lung infections may ultimately lead to lung destruction and
bronchiectasis later in life. Therefore prevention is an important part of
treatment, including adequate immunizations and avoidance of secondhand smoke
and other toxic fumes.
Bronchiectasis is characterized by an increased amount of sputum production
(mucus produced and coughed up from the lung), recurrent infections, and gradual
loss of lung function leading to shortness of breath.
What causes bronchiectasis?
Bronchiectasis is caused by damage to the larger airway walls destroying the
muscles and elastic tissue layers that allow normal bronchial tubes to contract.
This damage decreases the ability of the lung to move and clear secretions that
are normally produced in the lung. These pooled secretions cause increased
potential for infection like pneumonia and bronchitis, which causes further
damage to the bronchial walls. As mentioned above, this results in a vicious
cycle in which increased damage leads to increased infection, leading to further
damage.
There are three primary types of bronchiectasis. These types are described by
their anatomical appearance.
Cylindrical bronchiectasis is the mildest form and reflects the loss of the
normal tapering of the airways. The symptoms may be quite mild, like a
chronic
cough, and usually are discovered on CT scans of the chest.
Saccular bronchiectasis is more severe, with further distortion of the
airway wall and symptomatically, affected persons produce more sputum.
Cystic bronchiectasis is the most severe form of bronchiectasis, and fortunately it is the
least common form. This often occurred in the pre-antibiotic era when an
infection would run its course and the patient would survive with residual lung
damage. These patients often would have a chronic productive cough, bringing up
a cup or more of discolored mucus each day.
Bronchiectasis also may be congenital or acquired.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Pulmonary hypertension is an abnormal elevation of the pressure in the pulmonary circulation caused by the constriction of the blood vessels that supply blood to the lungs. Shortness of breath and dizziness are symptoms of pulmonary hypertension. Treatment involves diuretics, blood thinners, calcium channel blockers, and using supplemental oxygen to increase blood oxygen levels.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
Pneumonia is a lung infection that can be caused by
different types of microorganisms, including bacteria, viruses, and fungi.
Symptoms of pneumonia include cough with sputum
production, fever, and sharp chest pain on inspiration (breathing in).
Pneumonia is suspected when a doctor hears abnormal
sounds in the chest, and the diagnosis is confirmed by a chest X-ray.
Bacteria causing pneumonia can be identified by sputum
culture.
A pleural effusion is a fluid collection around the
inflamed lung.
Bacterial and fungal (but not viral)
pneumonia can be treated with antibiotics.
What is pneumonia?
Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died fro...
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